Prescriptive Approach Works in Kalamazoo

Since beginning a prescriptive oxygenation approach at Borgess Medical Center two years ago, the perfusion team has documented reductions in patient blood transfusions and related cost savings, according to David Klein, CCP, Director of Perfusion at Borgess Medical Center in Kalamazoo, Michigan.

“It’s not ‘one size fits all’ for our program -- it’s ‘what size is best for the patient?’” he says. “When we tailor our oxygenation approach, it allows us to meet our patient’s needs better.”

Mr. Klein’s team began purchasing the CAPIOX® FX Oxygenator with integrated arterial filter two years ago because of its low prime volume. They also appreciate the three sizes of the FX oxygenator -- since different sized patients have different oxygenator and blood management needs.

“The prescriptive oxygenation approach has the greatest impact on our smaller patients,” Mr. Klein adds.

Hospital Documents Cost Savings
While perfusionists recognize the clinical benefits to blood management programs, hospital administrators appreciate cost savings. Mr. Klein and his team presented these figures to Borgess Medical Center administration reflecting savings from 2009 to 2010:

• Lowering prime volume and adding Xcoating™ to the tubing has reduced albumin use to 8 percent of cases -- with a cost savings of more than $14,000.
• Blood use declined from an average of 0.46 units per case to 0.08 units per case -- creating additional savings of at least $43,500.

“We spent a little extra money on the front end,” Mr. Klein affirms, “and now we’ve saved significant costs on the back end.”

Two related enhancements made the transition easier for the Borgess Medical Center perfusionists:

• Each sterile custom tubing pack is identical and can easily connect with either the CAPIOX FX15 or FX25 oxygenator with integrated arterial filter – once the patient size is determined.
• The oxygenator holder easily slides and adjusts to hold the smaller FX15 or larger FX25 oxygenator.

Incremental Change
It is the clinician’s quest to improve patient care and the administrator’s goal to identify cost savings. Along the way, it’s the arduous, incremental journey that brings those results. Mr. Klein says that Borgess Medical Center perfusionists have always had a successful blood management program. His team made the following changes in the past few years to further account for their continuing improvements:

• Purchased the Terumo® Advanced Perfusion System 1. Now instead of a fixed pump head on the heart-lung machine base, the team now remote mounts the pump head closer to the oxygenator – further reducing the tubing length and prime volume.
• Moved the heart-lung machine closer to the patient to further shorten the tubing lines which additionally lower the prime volume.
• Used retrograde autologous priming (RAP) and antegrade autologous priming (AAP) as much as possible.

“We’re growing, changing and learning to improve our practice” with input from his Terumo Sales Manager and Clinical Specialists, says Mr. Klein. “Each year, we will have an ongoing, incremental push to further improve patient care.”